ARLINGTON, Texas — Cases like that of Martha Perez, a 26-year-old woman whose family said they felt pressured to donate her organs in Arlington, Texas, last month, following a tragic car crash, highlight public uncertainty about the medical definition of “brain death.”
“But she still has heart and lung functions,” family member Juan Martinez told MyFoxDFW.com before her organs were harvested. “They took her off life support, and she was still breathing. My family feels pressured, and it’s just hard for someone to make that kind of decision when this just happened.”
To avoid public confusion over complicated definitions like “brain death,” some doctors and bioethicists are now saying it would be better — and more “honest” — to simply allow the killing of patients by surgically removing their vital organs. The so-called “dead-donor rule” — the long-held ethic that says doctors must not end their patients’ lives by extracting their organs — is not followed in practice anyway, say the critics, so why have it?
And, according to a recent poll published in the British Medical Journal, more than 75% of Americans support harvesting patients’ vital organs — even if it kills them.
“Brain-dead organ donors are the principal source of transplantable organs. However, it is controversial whether brain death is the same as biological death,” said the study,“Abandoning the Dead-Donor Rule? A National Survey of Public Views on Death and Organ Donation. “Therefore, it is unclear whether organ removal in brain death is consistent with the ‘dead-donor rule,’ which states that organ removal must not cause death.”
The study’s lead author, Florida State University College of Medicine philosopher/ethicist Michael Nair-Collins, and his colleagues conducted an Internet survey of 1,096 Americans. Those surveyed were presented with a “vignette” of a man in an irreversible coma following a car accident who is unaware, cannot feel pain and has previously consented to organ donation.
“Of the 85% of the sample who agreed that they were willing to donate organs after death, 76% agreed that they would donate in the scenario of irreversible coma with organ removal causing death. There appears to be public support for organ donation in a scenario explicitly described as violating the dead-donor rule,” the study concluded.
‘Brain Death’ Challenged
Nair-Collins justifies harvesting organs from living persons, in part, by attacking the legitimacy of the concept of “brain death” that is utilized in some cases to define a person as dead even though some basic life functions remain operative.
“Patients who have been accurately diagnosed with ‘brain death’ according to accepted standards are able to engage in a large variety of integrative, feedback-driven biological functions that work together to maintain the internal physiologic stability for the organism as a whole and can do so over very long periods of time,” Nair-Collins told the Register.
“This includes things like getting a fever in response to an infection, healing wounds, regulating the amount of salt and water in the blood, absorbing nutrients through the gut and generating waste products and exchanging oxygen and carbon dioxide through the lungs,” he added. “Some of these patients also show increased blood pressure and heart rate in response to surgical incision. And, finally, more dramatic examples include sexual maturation in children and gestation of a fetus in pregnant women. … For these reasons, many scholars, including myself, have concluded that ‘brain-dead’ patients are biologically alive.”
If this scientific criticism of brain-death diagnoses is accurate, then it follows that organ removal causes the biological death of the donor.
“In other words, we do not follow the dead-donor rule in practice now,” Nair-Collins added.